Experts from NYU Langone Orthopedics will present their latest clinical findings and research discoveries at the American Academy of Orthopaedic Surgeon's (AAOS) 2022 Annual Meeting, March 22 to 26, in Chicago.
Topics presented will include: quality and access implications of regulatory changes related to total joint replacement; how multidisciplinary case conferences improve outcomes among high-risk spine surgeries; and using augmented reality to improve hip fracture repairs.
"Our clinical teams continue to innovate and investigate to provide our patients with the best possible outcomes—that is evident in the diversity of presentations featured this year," says Joseph Zuckerman, MD, FAAOS, the Walter A. L. Thompson Professor of Orthopedic Surgery, chair of the Department of Orthopedic Surgery at NYU Langone, and former president of AAOS. "We also congratulate Dr. Claudette Lajam, our chief safety officer and a leader of our orthopedic health equity initiatives, on her appointment as chair of the AAOS Board of Councilors. She is the first Latina chair and only the second woman to serve in the role. Congratulations as well to Dr. Toni McLaurin, our director of diversity, equity and inclusion, for her selection as member-at-large on the AAOS Board of Directors."
NYU Langone Orthopedics is ranked No. 4 in the nation by U.S. News and World Report, performs more than 23,000 orthopedic procedures annually and includes over 200 orthopedic physician faculty experts.
At this year's meeting, NYU Langone orthopedic and sports medicine specialists will present 65 papers, 74 posters, 18 videos, and 20 symposia, courses, and special sessions. Notable research from this year's conference includes:
Paper 664: Multidisciplinary Conference for Complex Surgery Leads to Improved Quality and Safety
Surgery to treat complex spinal deformities are known to have high rates of complications, with minor and major complication rates as high as 70 percent among adults. With the goal of decreasing rates of adverse outcomes, NYU Langone initiated multidisciplinary preoperative conferences beginning in February 19, 2019, and studied the effect on quality and safety. Clinical specialists in orthopedic spine surgery, neurosurgery, anesthesia, intraoperative monitoring neurology, and neurological intensive care conducted weekly conferences to review high-risk spinal deformity cases and develop comprehensive, multidisciplinary treatment plans.
The study reviewed 167 patient cases prior to February 19, 2019, and 96 cases after the conferences began. Patients in the before-conference group averaged 54.6 years old, while the after-conference group averaged 60 years old. Both groups had similar demographics, with a majority of female patients in each (about 70 percent). The after-conference group showed decreased levels of blood loss, a reduced number of intraoperative complications, fewer deep surgical site infections, and a reduced rate of postoperative motor deficits. Other factors, such as operative time, length of stay, postoperative transfusion, and neuromonitoring signal loss, were similar among both groups.
Researchers concluded that a multidisciplinary conference for complex spine surgery patients resulted in decreased 30- and 90-day reoperation and readmission rates as well as fewer intraoperative complications and postoperative deep surgical site infections.
"Spinal deformity surgery is one of the most complicated and high-risk operations in our field," says Charla Fischer, MD, FAAOS, co-author of the study and associate professor in the Department of Orthopedic Surgery's Division of Spine Surgery. "This single-center study shows how impactful multidisciplinary conferences are before high-risk, complex spinal deformity surgeries. It's critical for institutions to develop this protocol to achieve the best outcomes for their patients."
Paper 272: Removal of Total Hip and Total Knee Arthroplasty from the Inpatient Only List: Impact on Health Disparities
In 2020, the Centers of Medicare and Medicaid Services (CMS) removed total hip and knee replacement from the so-called Inpatient Only list, which determines the procedures that are required to take place in a hospital inpatient setting to be eligible for Medicare coverage. Researchers at NYU Langone investigated the impact this regulatory change may have had on health disparities among patients, using joint replacement cases from 2015 through 2021.
In reviewing 11,819 total knee arthroplasty (TKA) and 10,212 total hip arthroplasty (THA) cases, Black and Hispanic patients were less commonly designated as outpatients than were white patients. Black THA patients also had significantly higher rates of readmission than whites from 2018 to 2020, before THA was removed from the Inpatient Only list. There were no significant differences in readmissions across races or ethnicities.
"The implications of regulatory changes can be wide-ranging and lag behind available data," says Claudette M. Lajam, MD, FAAOS, senior author of the study and chief safety officer for the Department of Orthopedic Surgery. "Additional study is needed to ensure these broad changes to the Inpatient Only list are not restricting access to high-quality care. As surgeons, we're making decisions every day that impact lives and we want to make certain our policies lead to the best possible outcomes for every patient."
Paper 469: Improving Accuracy and Precision of Cephalad Lag Screw Placement in the Femoral Head During Cephalomedullary Nailing Using a Novel Augmented Reality System
Augmented and virtual reality technologies have seen substantial technological advances in recent years, leading to their increased use in surgery. Researchers investigated the use of
